Provider Demographics
NPI:1184774291
Name:ANGELWINGS COORDINATED CARE LLC
Entity type:Organization
Organization Name:ANGELWINGS COORDINATED CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEATY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-539-2227
Mailing Address - Street 1:HC 61, BOX 416 QUAIL DRIVE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:88039
Mailing Address - Country:US
Mailing Address - Phone:505-539-2227
Mailing Address - Fax:505-539-2225
Practice Address - Street 1:HC 61, BOX 416 QUAIL DRIVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:NM
Practice Address - Zip Code:88039
Practice Address - Country:US
Practice Address - Phone:505-539-2227
Practice Address - Fax:505-539-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM42284091Medicaid
NM53908325Medicaid